Provider Demographics
NPI:1447572110
Name:BALUCA, JENNIFER B (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:B
Last Name:BALUCA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 JOUGLARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-6931
Mailing Address - Country:US
Mailing Address - Phone:619-957-2583
Mailing Address - Fax:619-434-6041
Practice Address - Street 1:6435 JOUGLARD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-6931
Practice Address - Country:US
Practice Address - Phone:619-957-2583
Practice Address - Fax:619-434-6041
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse